BMC Health Services Research最新文献

{"title":"Implementation of cardiovascular disease risk prediction scores in Sub-Saharan Africa: a scoping review.","authors":"Mary Gouws, Naemi Araya, Elinor Harriss, Thomas A Gaziano, Mike English, Claire M Keene","doi":"10.1186/s12913-026-15378-1","DOIUrl":"10.1186/s12913-026-15378-1","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) risk prediction scores are widely recommended to guide primary prevention, yet their use in routine care across sub-Saharan Africa (SSA) remains limited. As the number of available scores continues to increase, understanding how they are implemented is important in closing the gap between policy and practice. This scoping review aims to map and synthesise the available literature on the implementation of CVD risk prediction scores in SSA.</p><p><strong>Methods: </strong>This review was conducted in accordance with JBI methodology. MEDLINE, Embase, Global Health (Ovid), CINAHL, Scopus and ProQuest Dissertations and Theses Global were searched. An Implementation Research Logic Model was used to structure data charting and synthesis across implementation determinants, strategies and outcomes.</p><p><strong>Results: </strong>Of the 4930 publications screened, 41 were included, representing 34 unique evidence sources across ten countries. Four use cases for CVD risk prediction scores were identified: (1) economic and policy considerations; (2) screening for high CVD risk and referral; (3) communication of risk and (4) treatment of high-risk individuals. The most frequently reported barriers to the use of risk scores related to health system and organisational challenges. Implementation strategies primarily focused on task-shifting, training, and short-term material or technological support for community health workers, whereas few studies evaluated strategies to support the uptake of CVD risk scores in health facilities. While feasibility and acceptability outcomes were widely studied, evidence on long-term sustainability of CVD risk scores was limited.</p><p><strong>Conclusion: </strong>The use of an Implementation Research Logic Model enabled structured synthesis of a heterogeneous and under-theorised evidence base, revealing a mismatch between the breadth of implementation determinants and the narrow range of strategies used to address them. The potential of CVD risk prediction scores, and other clinical prediction tools, to strengthen preventive care in SSA is unlikely to be realised without effective integration into routine health services. Therefore, moving beyond short-term, task-shifted screening pilots toward sustainable implementation approaches addressing the complete CVD care pathway will be essential to ensure that both existing and emerging risk prediction tools translate into equitable improvements in cardiovascular outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systems thinking in public health interventions: a systematic review of barriers and facilitators.","authors":"Mohammed Alabdulaali, Abeer Alharthi, Olga Siemers, Dana Alsuwaidan, Amani Alruwaili, Abrar Almutairi, Muaddi Alharbi","doi":"10.1186/s12913-026-15353-w","DOIUrl":"10.1186/s12913-026-15353-w","url":null,"abstract":"<p><strong>Background: </strong>Systems thinking has been promoted to address complex public health challenges involving fragmented systems, multi-sectoral governance, and interacting social determinants of health. However, its application in real-world public health interventions and the conditions influencing implementation remain understudied. This systematic review examines how systems thinking has been operationalized in public health interventions, identifies key facilitators and barriers to implementation, and interprets these findings in relation to broader public health practice and ongoing health system reforms in Saudi Arabia.</p><p><strong>Methods: </strong>We conducted a systematic review (2013-2025; final search November 2025) using PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. Studies applying systems thinking in population- or community-level public health interventions with implementation findings were included; conceptual and non-intervention studies were excluded. Data on approaches, frameworks, facilitators, and barriers were extracted and narratively synthesized. Quality was appraised using the MMAT (2018). The review was registered (PROSPERO; registration number CRD420251267775).</p><p><strong>Findings: </strong>Of 948 records identified, fifteen studies met the inclusion criteria, spanning communicable and non-communicable disease interventions across high-, middle-, and low-income countries. Systems thinking approaches included learning health systems, systems analysis and improvement approaches, community-based system dynamics, causal loop diagramming, and whole-system or multi-sectoral designs. Systems thinking was embedded within implementation processes, including iterative learning cycles, participatory system mapping, and quality improvement mechanisms. Key facilitators included stakeholder engagement and co-production, integration within existing health system structures, incremental capacity building, and leadership support. Barriers included challenges translating systems concepts into actionable interventions, workforce constraints, fragmented or non-interoperable data systems, rigid governance arrangements, and external disruptions such as COVID-19. Study designs were predominantly qualitative or mixed methods, with heterogeneity in evaluation approaches and limited long-term outcome assessment.</p><p><strong>Interpretation: </strong>Systems thinking in public health is applied mainly as an implementation-embedded practice rather than an analytical tool. Its effectiveness depends on participatory processes, adaptive learning, and supportive governance and data systems. These findings provide practical insights for health system reform contexts, including Saudi Arabia, where systems thinking can support integrated and adaptive public health interventions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing implementation of telemedicine in rural dementia care services in high-income countries: a scoping review.","authors":"Ronica Devarshi, Charlotte Myers","doi":"10.1186/s12913-026-15100-1","DOIUrl":"10.1186/s12913-026-15100-1","url":null,"abstract":"<p><strong>Background: </strong>Dementia care presents unique challenges in rural areas in high-income countries (HICs) due to limited access to specialised healthcare, fragmented services, and geographical isolation. Telemedicine has emerged as a promising solution, particularly accelerated by the coronavirus disease (COVID-19) pandemic. However, there remains a critical gap in understanding how telemedicine is operationalised within existing dementia care systems, particularly in rural contexts. The aim of this scoping review is to map and analyse existing evidence on the integration of telemedicine into dementia care systems in rural areas in HICs, with a specific focus on identifying barriers, facilitators, and strategies that shape effective implementation.</p><p><strong>Methods: </strong>This scoping review followed Arksey and O'Malley's framework, refined by Levac et al. and reported in accordance with PRISMA-ScR guidelines. Searches covered MEDLINE, Embase, Web of Science and CINAHL for studies published from January 2014 to March 2025. Records were screened against predefined eligibility criteria. Studies were included only where telemedicine involved synchronous, real-time, video-mediated clinical interaction. Data were extracted using a standardised form and analysed through thematic analysis. Themes were subsequently mapped to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) to structure interpretation across implementation levels.</p><p><strong>Results: </strong>Nine studies met the inclusion criteria across rural settings in the USA, Australia, Canada, Greece, and the United Kingdom. Telemedicine was delivered across home, facility, and community settings, with several studies using blended delivery models. Key barriers included limited connectivity, digital literacy, health impairments, and caregiver capacity. Key facilitators included trust and continuity in provider relationships, perceived practical advantages, and organisational support. Key strategies included training and capacity building, dedicated coordination roles, and co-design with caregivers and patients.</p><p><strong>Conclusion: </strong>The integration of telemedicine in rural dementia care systems in HICs is shaped by complex interdependencies between technological, organisational, and relational factors. Strengthening health system readiness requires investment in infrastructure, policy alignment, and inclusive design approaches that centre the needs of older adults with dementia, caregivers, and rural health systems.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term changes in employment status as a predictor of catastrophic health expenditure in South Korea.","authors":"Jeong Min Yang, Jieun Hwang","doi":"10.1186/s12913-026-15219-1","DOIUrl":"10.1186/s12913-026-15219-1","url":null,"abstract":"<p><strong>Background: </strong>South Korea faces persistent challenges in healthcare financing, with high out-of-pocket payments driving catastrophic health expenditure (CHE) among vulnerable households. Employment instability is a critical yet understudied determinant of CHE. Prior studies have largely examined employment changes in binary terms over short time frames. This study investigated the longitudinal association between employment status trajectories (EST) and CHE among Korean adults.</p><p><strong>Methods: </strong>This study utilized data from the 9th to 17th waves of the National Survey of Tax and Benefit. Of the 7,809 participants enrolled in the 9th wave, 1,123 were excluded due to missing data on employment status or covariates, yielding a final analytical sample of 6,686 participants. The study period was divided into two sequential analytic phases. In the first phase, group-based trajectory modeling was applied to waves 9-12 to identify distinct EST groups separately for adults aged under 50 and those aged 50 and above. In the second phase, generalized estimating equations were applied to waves 12-17 to estimate the association between the identified EST groups and CHE occurrence; the 12th wave served as both the endpoint for trajectory identification and the baseline for this follow-up. This two-phase sequential design minimized potential reverse causality by establishing EST patterns independently, prior to CHE occurrence, thereby preserving temporal order. CHE was defined following World Health Organization criteria as out-of-pocket medical expenditure exceeding household capacity to pay, with sensitivity analyses conducted at 20%, 30%, and 40% thresholds.</p><p><strong>Results: </strong>Among adults under 50 years, no significant association was observed between EST and CHE. Among those aged 50 and above, however, the sustained unemployment group showed 1.26, 1.25, and 1.34 times higher odds of CHE at the 20%, 30%, and 40% thresholds, respectively, compared to the sustained standard white-collar group. The \"changed white-collar to unemployment\" group similarly exhibited 1.32, 1.32, and 1.35 times higher odds at each threshold.</p><p><strong>Conclusions: </strong>Employment instability, particularly sustained unemployment and transitions into unemployment, significantly increases the risk of CHE among adults aged 50 and older in South Korea. Targeted medical cost support policies addressing groups with sustained unemployment or frequent employment transitions are essential to reducing household financial burdens from healthcare expenditure.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User evaluation of AI- and human-generated responses in digital health communication: a paired survey study.","authors":"Christin Schulz, Patrycja Adämmer, Emma Fechner, Eva Kassberg, Ida Laux, Ella Pollatscheck, Katja Porsch, Lady Romamti, Iryna Tymchuk, Johannes Gräske","doi":"10.1186/s12913-026-15305-4","DOIUrl":"https://doi.org/10.1186/s12913-026-15305-4","url":null,"abstract":"<p><strong>Background: </strong>Digital health communication is gaining importance as health care systems face increasing demand and structural constraints. Generative artificial intelligence (AI) tools such as ChatGPT are increasingly used for health information seeking; however, direct comparisons between AI-generated and human responses from the user perspective remain limited.</p><p><strong>Methods: </strong>A quantitative exploratory cross-sectional online survey using a paired-response design was conducted in Germany. The survey instrument was developed based on the study objectives and refined through pretesting. Participants evaluated two responses to the same real-world health query: one written by a physiotherapist and one generated by ChatGPT-4. Outcomes included perceived empathy, comprehensibility, perceived discriminatory content in the responses, and expert-rated clinical quality. Paired comparisons were analyzed using Wilcoxon signed-rank tests, and logistic regression models were applied to explore associations between participant characteristics and preference patterns.</p><p><strong>Results: </strong>The analytical sample comprised 224 participants. Across most items, the AI-generated response was rated more favorably than the human response, particularly with regard to comprehensibility and empathy (all p < .001). The AI-generated response was rated more favorably across both empathy and comprehensibility items, with highly comparable preference distributions between the two domains. Perceptions of discriminatory content were rare and did not differ significantly between responses. Expert evaluations also favored the AI-generated response in terms of clinical accuracy and completeness, although these findings should be interpreted cautiously given the exploratory design.</p><p><strong>Conclusions: </strong>The findings suggest that participants perceived the AI-generated response as aligning more closely with central user expectations for text-based health information, particularly regarding clarity and supportive language, although these findings should be interpreted cautiously given the substantial differences in length and structure between responses and the exploratory single-case design. At the same time, these perceptions should be considered alongside ongoing concerns regarding the clinical appropriateness, safety, and equity of AI-generated health information, which were not comprehensively assessed in the present study. The present findings therefore primarily provide evidence regarding user-perceived communication quality rather than the clinical validity of AI-generated responses. Accordingly, further research is needed to establish the clinical appropriateness, safety, guideline concordance, and potential role of AI-generated responses in healthcare consultation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"We built the ship as we sailed it\": exploring public health outreach targeting communities shaped by migration in Stockholm, Sweden during the COVID-19 pandemic.","authors":"Mattias Strand, Baidar Al-Ammari, Önver Cetrez, Soorej Jose Puthoopparambil, Sofie Bäärnhielm","doi":"10.1186/s12913-026-15396-z","DOIUrl":"https://doi.org/10.1186/s12913-026-15396-z","url":null,"abstract":"<p><strong>Background: </strong>Effective health crisis communication requires culturally sensitive, community-engaged approaches, particularly for reaching vulnerable populations. The COVID-19 pandemic exposed significant gaps in public health preparedness for communities shaped by migration. This study explores how public health staff in Stockholm, Sweden designed and delivered crisis communication targeting migrant populations during the pandemic.</p><p><strong>Methods: </strong>A qualitative study was conducted using eight individual in-depth interviews and three focus group discussions with 21 participants involved in planning, producing, and disseminating COVID-19 public health messages in Stockholm. Participants included public health strategists, communications officers, and frontline healthcare staff. Interview data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Four main themes emerged from the data, revealing a temporal evolution in outreach strategies. Initially, efforts focused heavily on language translation of standardized health messages. However, participants recognized this approach as insufficient and gradually shifted toward more dialogue-based engagement. Key developments included: (a) establishing trust through active involvement of community stakeholders such as religious leaders, neighborhood organizers, and social media influencers; (b) addressing structural barriers including overcrowded housing, precarious employment, and digital exclusion rather than assuming non-adherence reflected poor understanding; (c) counteracting stigma related to infection and vaccination; and (d) fostering creative problem-solving despite organizational rigidity and unclear coordination. Participants emphasized the importance of listening to the concerns in the community and co-developing solutions rather than simply disseminating information. However, many expressed concern that networks established during the pandemic and insights gained about structural inequalities were already being lost as systems \"returned to normal\".</p><p><strong>Conclusion: </strong>Public health authorities must move beyond one-way messaging toward sustained community partnership and dialogue-based engagement. Effective crisis preparedness requires addressing social determinants of health and building community networks during non-crisis periods, rather than relying on ad-hoc solutions during emergencies. Without institutional commitment to translating crisis experiences into lasting structural changes, authorities risk repeating past mistakes and eroding public trust-a critical concern given the likelihood of future health crises.</p><p><strong>Trial registration: </strong>The study protocol was preregistered on the Open Science Framework (osf.io/rt47j) on March 22, 2022.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absorbing the shock: the role of lower-level health facilities in immunization resilience in Sidama, Ethiopia during COVID-19 pandemic.","authors":"Abel Gedefaw, Neamin M Berhe, Nigus Bililign Yimer, Tsega Argaw, Misganaw Worku, Siraj Hussen, Mohammed Ayalew, Abebaw Amare, Dejene Hailu, Damene Debalke, Anteneh Asefa","doi":"10.1186/s12913-026-15386-1","DOIUrl":"https://doi.org/10.1186/s12913-026-15386-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although the COVID-19 pandemic disrupted routine immunization services globally, evidence from Ethiopia suggests limited overall impact. However, little is known about how immunization uptake varied across different facility levels and phases of the pandemic. This study examined these patterns in public hospitals, health centers, and health posts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and materials: &lt;/strong&gt;We conducted a longitudinal comparative study of routine immunization service uptake across 18 hospitals, 132 health centers, and 532 health posts in Sidama Regional State, Ethiopia. To assess disruption and recovery patterns, we compared immunization uptake among infants under one year of age during the first 12 months of the pandemic (March 2020-February 2021) with the corresponding pre-pandemic period (March 2019-February 2020). We extracted data from the District Health Information System (DHIS2) and calculated percent changes with 95% confidence intervals. We compared mean differences in uptake using a paired t-test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, immunization uptake increased by 9.72% (95% CI: 9.66%-9.79%) (P = 0.006) during the first six months of the pandemic (March-August 2020), compared to the same pre-pandemic period. While hospitals experienced a decline of 5.2% (P = 0.449), health centers and health posts experienced significant increases of 7.96% (P = 0.015) and 11.5% (P = 0.002), respectively. Compared to the six months immediately before the pandemic (September 2019 - February 2020), overall uptake increased by 3.90% (P = 0.144), with a 14.01% decline in hospitals (P = 0.151), and increases of 4.05% (P = 0.275) and 5.45% (P = 0.032) in health centers and health posts, respectively. During the post-lockdown period (September 2020 - February 2021), immunization uptake increased by 5.11% (P = 0.007) compared to the same pre-pandemic period, including rises of 18.7% in hospitals (P = 0.208), 2.5% in health centers (P = 0.031) and 4.6% in health posts (P = 0.004). Compared to the first half of the pandemic, hospital-level immunization uptake increased significantly by 38.15% (p &lt; 0.001). However, overall uptake increased only by 1.16% (p = 0.461), while there were non-significant declines of -0.76% (p = 0.627) in health posts and - 1.45% (P = 0.790) in health centers. Over the full 12-month pandemic period, total uptake increased significantly by 7.35% (p &lt; 0.001) compared to the previous year. Health posts showed the largest gain (7.99%; p &lt; 0.001), followed by health centers (5.2%; p = 0.003); and non-significant rise of hospitals (5.3%; p = 0.376). Uptake of all vaccine types increased annually, except for BCG, which showed a non-significant decline (p = 0.889).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Immunization services in the region remained resilient during the pandemic across all vaccine antigens, primarily due to the capacity of health posts and health centers to absorb increased demand following dis","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting to best practice: a practice-oriented checklist for monitoring clinic-level fidelity to hypertension interventions in a large safety-net healthcare system.","authors":"Ariella R Korn, Priya Gandhi, Alex R Dopp, Juan Barron, Ramon Casillas-Salazar, Christina Durant, Maria G Morales, Enricka Norwood-Scott, Savanna L Carson, Alejandra Casillas, Alison B Hamilton, Brian S Mittman, Nina Park, Rhonda Polzin, Atkia Sadia, Utpal Sandesara, Sae Takada, Soma Wali, Amelia R Weldon, Arleen F Brown","doi":"10.1186/s12913-026-15344-x","DOIUrl":"10.1186/s12913-026-15344-x","url":null,"abstract":"<p><strong>Background: </strong>Practical tools are needed to monitor and support progress toward high-fidelity implementation of evidence-based practices designed to change patients' health behaviors and improve clinical outcomes. This article describes the development and baseline use of a clinic-level fidelity checklist for a multilevel intervention bundle of nine hypertension evidence-based practices in primary care.</p><p><strong>Methods: </strong>Collaborating with partners from a large U.S. safety-net healthcare system, we developed a checklist with categorical clinic-level fidelity ratings (\"little or none,\" \"partial,\" \"complete\") for each of the nine evidence-based practices. Trained facilitators complete the checklist with clinic champions to assess fidelity and identify areas for improvement. One of five facilitators rated fidelity at baseline for each of 19 participating clinics.</p><p><strong>Results: </strong>Feedback from facilitators and staff led to clinic fidelity checklist revisions and improvements, including standardizing ratings and documentation across clinics and facilitators, and clarifying criteria specific to an evidence-based practice (e.g., use of a hypertension registry, treatment intensification protocol with fixed-dose combination medications). Baseline clinic ratings indicated some evidence-based practices were already well-established (e.g., standardized blood pressure measurement, screening for social needs and linkage to community resources) whereas others showed areas for improvement (e.g., use of a hypertension registry, use of posters to encourage behaviors related to hypertension care), guiding facilitators' support of clinic needs.</p><p><strong>Conclusions: </strong>Use of a simple fidelity monitoring checklist, completed in partnership with facilitators and clinic staff, identified opportunities to improve the implementation of evidence-based practices for hypertension care at each clinic while also refining the tool. Moving forward, quarterly checklist completion will allow monitoring of changes over time, helping facilitators tailor support to clinic needs to further drive successful EBP implementation. Our approach may be applicable for developing fidelity monitoring tools in other contexts.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov NCT06359691 (original registration date 2024-04-08).</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The UN Decade of healthy ageing in practice: A qualitative case study on perspectives of healthy ageing among older adults, healthcare professionals, and decision-makers in Norway.","authors":"Mariya Bikova, Maria Nordheim Alme, Djenana Jalovcic, Hanne Tuntland","doi":"10.1186/s12913-026-15363-8","DOIUrl":"https://doi.org/10.1186/s12913-026-15363-8","url":null,"abstract":"<p><strong>Background: </strong>Global populations are ageing, making healthy ageing an increasingly important priority. In Norway, the number of people aged 70 and above is expected to double by 2050. The UN Decade of Healthy Ageing (2021-2030) guides Norway's national programs on healthy ageing through its four action areas: combating ageism, age-friendly environments, integrated care and long-term care. The aim of this study is to explore how healthy ageing is understood and interpreted in Norway in light of the four action areas of UN's Decade of Healthy Ageing and the enabler listening to diverse voices and meaningful engagement.</p><p><strong>Methods: </strong>The study draws on 23 semi-structured interviews with decision-makers, healthcare professionals, and older adults in a large urban Norwegian municipality. Participants were recruited through direct contact and through the municipality. Data from the interviews was transcribed verbatim and analysed collaboratively by the research team, following the principles of collective qualitative analysis.</p><p><strong>Results: </strong>Findings focus on three main themes: strategies for achieving mastery, mixed perceptions of ageing, and health services. Results indicate that while preparing for old age is seen as a collective responsibility, older adults are increasingly expected to prepare for old age. The emphasis on self-reliance risks marginalising vulnerable groups who lack necessary resources or support networks. The rapid digitalisation of everyday life is identified as significant barrier to equitable participation, underscoring the urgent need to foster more inclusive forms of active engagement. Municipal healthcare services are generally perceived as high-quality, but face resource challenges that create uncertainty among older adults.</p><p><strong>Conclusions: </strong>Healthy ageing in Norway is increasingly framed around participation and shared responsibility for ageing in place, reflecting the UN Decade of Healthy Ageing. However, growing individualisation and rapid digitalisation may reinforce inequities. Addressing this requires digital inclusion, intergenerational approaches, accessible environments, and sustained public investment, alongside efforts to combat ageism and promote more inclusive, collaborative forms of participation.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the health management journey of allogeneic hematopoietic stem cell transplantation: a qualitative study.","authors":"Jiang Nan, Wu ZuXia, Zhao XiaoMin, Tang XueMei, Jiang ShanWen, Cheng Qing, Tu MeiJuan","doi":"10.1186/s12913-026-15348-7","DOIUrl":"10.1186/s12913-026-15348-7","url":null,"abstract":"<p><strong>Background: </strong>Allogeneic hematopoietic stem cell transplantation serves as a curative therapy for various hematologic disorders. However, existing care models often lack a holistic perspective on patients' entire journey from diagnosis to long-term survival.</p><p><strong>Objective: </strong>This study employs patient journey mapping to systematically analyze the comprehensive health management needs of allo-HSCT patients throughout their entire treatment cycle.</p><p><strong>Methods: </strong>We adopted a descriptive qualitative design. Semi-structured interviews were conducted with 16 allo-HSCT patients between November and December 2025. Interview data were analyzed using inductive content analysis. Interview data were analyzed using conventional inductive content analysis.</p><p><strong>Results: </strong>The patient treatment process was delineated into four distinct phases-screening and evaluation, transplantation, maintenance therapy, and long-term follow-up-with a total of 31 themes identified across three dimensions: task execution, emotional states, and pain point management. The symptom burden shifted dynamically throughout the treatment trajectory: psychological distress and decisional paralysis dominated the screening phase, escalating into concurrent acute physical symptoms during transplantation, and eventually transitioning to persistent functional decline driven by chronic graft-versus-host disease in long-term survivorship. Emotional experiences followed a parallel trajectory-from intense information needs and guilt in the screening phase, to profound isolation and emotional ambivalence during transplantation, and finally to a complex interplay of resilience and helplessness in the face of lasting sequelae during recovery. Across all phases, systemic pain points consistently centered on fragmented care transitions, a persistent misalignment between information provision and patients' evolving needs, a lack of sustainable support for lifelong self-management, and the compounding impact of financial strain and social role loss.</p><p><strong>Conclusion: </strong>The patient journey map constructed in this study offers a visual framework for understanding the holistic care needs of allo-HSCT patients across the entire trajectory and pinpoints four critical intervention nodes. Based on these findings, we recommend implementing phase-tailored health education aligned with patients' evolving cognitive needs, integrating routine financial toxicity screening into standard care pathways, strengthening structured transitional support at discharge, and establishing long-term survivorship programs that encompass vocational rehabilitation and peer support networks. These evidence-informed strategies can facilitate the transition from fragmented, event-driven care to integrated, patient-centered care across the entire transplant continuum.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}